PB1830: HIGH EARLY MORTALITY RATES IN OLDER PATIENTS WITH ACUTE MYELOID LEUKEMIA TREATED WITH INTENSIVE CHEMOTHERAPY IN TWO ACADEMIC CENTERS IN BRAZIL
Authors: F. Lisboa Nogueira, F. Rodrigues Mendes, R. da Costa Bandeira de Melo, W. Fernandes da Silva Junior, A. B. Firmato Glória, S. Guerra Xavier, I. Bendit, E. Maranhão Fagundes, E. Deolinda Rodrigues Pereira Velloso, E. Magalhães Rego
Journal: HemaSphere (2022)

Background: Most patients with acute myeloid leukemia (AML) are 60 years old or more at diagnosis. They represent a challenging to treat population due to their heterogeneity, exemplified by different levels of fitness and comorbidities. Data from younger patients treated in middle-income countries with intensive chemotherapy point out to higher early death rates, mainly owing to infections. The outcomes of older patients treated in the same setting, however, are largely unknown. Moreover, the determination of factors driving early death in these countries is expected, since it can provide guidance on measures to reduce it, including better patient selection to intensive induction. Aims: To access the early mortality rate in older AML patients in two teaching hospitals in Brazil and describe the risk factors. Methods: Patients aged 60 years old or older, diagnosed with AML from 2011 to 2019 and treated with intensive chemotherapy at the Instituto do Câncer do Estado de São Paulo (ICESP) or the Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG), were retrospectively included in the cohort. Those testing positive for BCR-ABL1 were excluded. Diagnosis was performed as per WHO criteria. Cytogenetic and molecular analysis for RUNX1-RUNX1T1, CBFβ/MYH11, FLT3-ITD, NPM1 were routinely performed. Patients were classified according to the Adapted Genetic Risk (AGR) as previously described by Silveira DRA et al. Clinical data and basal laboratory values were retrieved from medical charts. Early death was defined as mortality within 30 days of the beginning of induction chemotherapy. The study was approved by each institution`s review board. Results: Ninety-five patients, 65 (68.4%) from ICESP and 30 (31.6%) from HC-UFMG fulfilled the study criteria. The median follow-up was 24.2 months (follow-up rate of 95.8%). The median age was 65 years old (range 60-74) and 41 (43.2%) were female. Patients from ICESP were slightly older (median 66 vs. 65; p=0.041). The Charlson comorbidity index (CCI), which scores points for age and some co-diagnosis yielded a median value of 2, with 57 (60.0%) patients without any comorbidity scored on CCI. Cytogenetics returned no metaphasis on 14 (14.7%) patients. According to the AGR, 28 (34.6%) were assigned to favorable, 28 (34.6%) to intermediate and 25 (30.9%) to the adverse risk category, while 14 (14.7%) patients were not classified due to missing data. Eighty-eight (92.6%) received 7 + 3 and 4 (4.2%) FLAG. Thirty-eight (40.0%) patients achieved complete remission and 16 (16.8%) were refractory to the first induction cycle. No patient has undergone hematopoietic stem cell transplantation. Thirty-nine (41.1%) patients died within 30 days of the start of induction. On multivariate analysis, CCI above 2 (HR 5.52; p=0.006), higher creatinine (HR 2.84; p=0.043), lower albumin (HR 0.34; p<0.001) and higher total bilirubin (HR 7.25; p=0.034) were associated with early death. Sixty-two (65.3%) were admitted to intensive care unit during induction, 12 (12.6%) started hemodialysis and 29 (30.5%) had a diagnosis of invasive fungal infection. Median overall survival was 3.7 months. According to AGR, median overall survival was 6.8 months on favorable and 1.2 month on adverse risk group (p=0.012). Image:Summary/Conclusion: Early death rates proved to be exceedingly high despite the favorable characteristics of the cohort, which included mainly patients aged less than 70 years old and with a low comorbidity burden. In this adverse scenario, predictive factors can help to identify who benefits the most from intensive induction.